The pathology of encephalic arteriovenous malformations treated by prior embolotherapy

Summary A pathologic study was undertaken of seven encephalic arteriovenous malformations, including five resected from one to seven days after balloon embolization, one resected 10 days after embolization with polyvinyl alcohol foam (PVA), and a large mesencephalic AVM in a patient who died eight weeks after a series of embolization procedures with PVA and silicone spheres. AVM's resected 6–7 days following balloon embolization showed focal mural and adventitial inflammatory infiltrates and parenchymal (i.e. non-vascular) necrosis of a large portion of one AVM. The AVM examined 7 days post-balloon embolization showed an intraluminal thrombus containing refractile particles surrounded by foreign body giant cells (FBGC's). The AVM removed 10 days after PVA embolotherapy showed mural and perivascular necrosis with infiltration by polymorphonuclear leukocytes. The single autopsy case showed FBGC's surrounding residual PVA, refractile particles deep within vascular walls, and marked mural thickening of AVM channel walls, changes that may represent a response to previous angionecrosis and inflammation at the time of embolization. These findings, the pathogenesis of which is discussed in detail, may help to explain some of the rare complications of iatrogenic embolotherapy with these materials, as well as providing evidence for the basis of their efficacy.Presented in part at the 63rd Annual meeting of the American Association of Neuropathologists, Seattle, Washington, June, 1987     

103例肝硬化脾机能亢进脾栓塞治疗的疗效观察

2001年1月至2005年1月我院对103例肝硬化门脉高压患者进行了部分脾动脉栓塞(PSE)治疗,观察术前1周、术后4周及6个月随诊脾静脉宽度、脾脏厚度及外周血象的变化,并对其临床意义进行探讨.     

How to Treat Peripheral Arteriovenous Malformations

Arteriovenous malformations (AVMs) are direct communications between primitive reticular networks of dysplastic vessels that have failed to mature into capillary vessels. Based on angiographic findings, peripheral AVMs can be classified into six types: type I, type IIa, type IIb, type IIc, type IIIa, and type IIIb. Treatment strategies vary with the types. Type I is treated by embolizing the fistula between the artery and the vein with coils. Type II (IIa, IIb, and IIc) AVM is treated as follows: first, reduce the blood flow velocity in the venous segment of the AVM with coils; second, perform ethanol embolotherapy of the residual shunts. Type IIIa is treated by transarterial catheterization of the feeding arteries and injection of diluted ethanol. Type IIIb is treated by transarterial or direct puncture approaches. A high concentration of ethanol is injected through the transarterial catheter or direct puncture needle. When the fistula is large, coil insertion is required to reduce the amount of ethanol. Type I and type II AVMs showed the best clinical results; type IIIb showed a satisfactory response rate. However, type IIIa showed the poorest response rate, either alone or in combination with other types. Clinical success can be achieved by using different treatment strategies for different angiographic AVM types.     

脾动脉瘤反复出血栓塞治疗1例

患者男,22岁.1年前因腹部刀刺伤后在当地医院行剖腹探查、胰腺修补术,术后4个月时出现腹部不适,经当地超声检查诊断为"胰腺假性囊肿",遂行手术治疗,术后出现胰瘘并行外引流术.     

Comparison of embolic agents for varices during transjugular intrahepatic portosystemic shunt for variceal bleeding: Tissue gel or coil?

PurposeWe aimed to compare treatment efficacy, safety and material cost between tissue gel and coil regarding variceal embolization during transjugular intrahepatic portosystemic shunt (TIPS).Materials & Methods: This retrospective study including cirrhotic patients with variceal bleeding treated with TIPS combined with variceal embolization between January 2016 and August 2017. Patients were divided into three groups according to embolic agents used in variceal embolization: tissue gel group (Group A), combination group (Group B), and coil group (Group C). The primary endpoint was 1-year rebleeding rate after TIPS creation. The secondary endpoints included shunt dysfunction, overt hepatic encephalopathy, liver function, and embolic agents-related expense.ResultsA total of 60 patients (30, 10, and 20 in Group A, B, and C) were included. Variceal rebleeding occurred in 3 (10%), 0 (0%), and 4 (20%) patients within one year after TIPS creation in Group A, B, and C, respectively. Stent dysfunction occurred in 2 (3.3%) patients and 9 (15.0%) patients experienced overt hepatic encephalopathy. No significant differences were observed between three groups regarding primary and secondary endpoints except embolic agents-related expense, with a significantly lower cost in Group A when compared to the other two groups. Stent dysfunction occurred in two patients, with one patient in Group A developed acute occlusion caused by thrombus and another patient in Group C underwent stent stenosis during follow-up.ConclusionsCompares to coil alone or combines with coil, tissue gel has similar treatment efficacy and safety, but with significantly lower cost for variceal bleeding during TIPS.     

热碘油经微导管栓塞技术在肝癌介入治疗中的应用

目的研究应用热碘油经微导管栓塞技术在肝癌介入治疗中的临床价值。方法26例结节型肝癌(原发性肝癌23例,转移性肝癌3例)患者接受了78次微导管栓塞术治疗。均施行瘤内热碘油(65℃)栓塞术,其中载瘤动脉保护性血栓栓塞术3次,瘤内动-静脉瘘无水酒精栓塞术3次。结果26例均获得瘤体内完全性、充填性栓塞。3例患者发生上腹部不适,2例经手术切除证实瘤体完全坏死。随访14～26个月,所有患者均存活,未发生严重并发症。结论采用热碘油经微导管栓塞技术治疗肝癌可明显提高治疗效果;充分超选到位、逐支栓塞、脉冲挤压式充填法和灵活的微导管应用技术是栓塞成功的关键。     

动脉栓塞治疗肝血管瘤28例临床分析

目的：评价平阳霉素碘油乳剂（PLE）肝动脉栓塞治疗对肝血管瘤的临床疗效。方法：治疗肝血管瘤28例,采用Seldinger技术股动脉插管,导管超选择插至肝血管瘤供血动脉后,灌注平阳霉素碘化油乳剂。所有病例术后随访3～18个月。结果：肝动脉栓塞后肝血管瘤瘤体内碘油沉积良好,22例（78.6%）血管瘤瘤体直径缩小〉50%,4例（14.3%）瘤体直径缩小〈50%,2例无明显变化,未发生严重并发症。结论：PLE肝动脉栓塞治疗肝血管瘤疗效及安全性良好。     

子宫肌瘤的子宫动脉栓塞治疗

目的 研究子宫肌瘤的动脉栓塞治疗的临床应用。方法 采用Seldinger方法超选择性子宫动脉栓塞治疗18例子宫肌瘤患，用PVA阻断瘤体血供。结果 血管造影可见肌瘤血供阻断。术后6个月随访结果表明肌瘤瘤体明显缩小．临床症状改善。结论 子宫动脉栓塞治疗子宫肌瘤是一种创伤小的新方法。     

大咯血介入栓塞治疗的观察与护理

通过对28例大咯血患者行介入栓塞治疗的护理，认为做好术前准备、术中配合是介入栓塞治疗得以顺利进行和成功的关键，做好术后护理是预防和减少并发症发生的保证。     

The pathology of arteriovenous malformations of the brain treated by embolotherapy

Light microscopic and immunohistochemical examination was undertaken of intracranial arteriovenous malformations (AVMs) surgically resected from 18 patients, each of whom had undergone preoperative angiographic embolization with multiple agents. Distinct patterns of tissue reaction to these agents were noted, even when more than one substance was present in a vascular lumen. Avitene produced the mildest tissue response but resulted in relatively early endothelialization and recanalization. Cyanoacrylates were longer-lasting but associated with more acute and chronic (including granulomatous) inflammation and vessel wall changes. Polyvinyl alcohol foam/ethanol mixture had intermediate properties. Endothelial proliferation over embolization material was confirmed using immunohistochemical application of an antibody to cell proliferation-specific proteins. The significance of these findings for combined endovascular and surgical treatment of cerebral vascular malformations is discussed.